Provider Demographics
NPI:1497058887
Name:WRIGHT MEDICAL GROUP INC
Entity Type:Organization
Organization Name:WRIGHT MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:COX
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:941-457-0071
Mailing Address - Street 1:4055 TAMIAMI TRL
Mailing Address - Street 2:STE 23
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33952-9212
Mailing Address - Country:US
Mailing Address - Phone:941-457-0071
Mailing Address - Fax:941-624-6193
Practice Address - Street 1:4055 TAMIAMI TRL
Practice Address - Street 2:STE 23
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-9212
Practice Address - Country:US
Practice Address - Phone:941-457-0071
Practice Address - Fax:941-624-6193
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-07
Last Update Date:2010-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME80723207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME80723OtherSTATE LICENSE NUMBER